| NPI | 1669551438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE KOHL Administrator 315-235-7141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NY 510-E-007) |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2025-07-31 |